States have great latitude to determine the scope of dental benefits they cover for adults through their Medicaid programs. Some states cover comprehensive benefits, others cover emergency dental care and some none (AZ provides emergency coverage up to $1000 per year for all adults and comprehensive coverage for kids). This variation in coverage matters. Without adequate dental coverage, people face barriers to getting care they need to stay healthy.
To better understand the consequences of insufficient dental coverage, Families USA conducted a survey of states that cover emergency-only dental services. In the issue brief Families USA found:
- States that cover emergency dental services generally cover some services to address severe pain including extractions. But most don’t provide restorative care nor cleanings that would address underlying disease.
- In some states, Medicaid managed care plans provide plan-specific “value added” benefits.
- State Medicaid programs pay for hospital emergency department visits when appropriate dental services are not available.
- More comprehensive benefits and fewer prior authorization requirements would encourage provider participation.
- Low-income seniors and people with disabilities who rely on Medicaid and Medicare for health coverage are among those affected by the lack of dental coverage.
The Families USA Issue Brief concludes that emergency-only dental coverage is a start, but states should invest in comprehensive Medicaid dental coverage for adults if they want to effectively keep their populations healthier and reduce other health care costs. Here’s the full the full issue brief.